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A new species (Marcopoloichthys mirigioliensis) of the stem teleosteomorph genus Marcopoloichthys is described from the lower Besano Formation (late Anisian at Monte San Giorgio, southern Switzerland), making this new species distinct from Marcopoloichthys furreri from the Prosanto Formation (early Ladinian at Ducanfurgga, southeastern Switzerland). Marcopoloichthys mirigioliensis n. sp. is smaller (ca. 32 mm standard length) than M. furreri (ca. 40 mm standard length), and in addition, the two species have some important differences in the caudal endoskeleton and fin, e.g., number of epaxial and hypaxial basal fulcra, uroneural structure, size of hypurals, and presence versus absence of urodermals. Marcopoloichthys mirigioliensis n. sp. is the smallest member of Marcopoloichthyidae which is currently known from at least five species living in the Triassic of China (one species), Italy (two and others that remain undescribed), and Switzerland and according to current information, with its ca. 32 mm standard length is candidate to be considered a miniature fish. Additionally, this size makes it the smallest known stem teleost. As in other marcopoloichthyids, the buccal and suspensorium anatomy of M. mirigiolensis n. sp. corresponds to that of suction-feeder fishes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the effect of training with a personal, portable laparoscopic endo-trainer (PLET) on residents' laparoscopic skills. Methods: The study took place at a tertiary-care academic university hospital in Switzerland. All participants were randomized to either a home- or hospital-based PLET training group, and surgical skill performance was assessed using five laparoscopic exercises. 24 surgical residents, 13 females and 11 males, were enrolled at any training stage. Nine residents completed the assessments. Endpoints consisted of subjective and objective assessment ratings as well as exercise time and qualitative data up to 12 weeks. The primary outcome was the difference in exercise time and secondary outcomes included performance scores as well as qualitative data. Results: The hospital-based training group performed exercises number 1, 3 and 4 faster at 12 weeks than at baseline (p =.003, < 0.001 and 0.024). Surgical skill performance was not statistically significantly different in any of the endpoints between the hospital- and home-based training groups at 12 weeks. Both the subjective and objective assessment ratings significantly improved in the hospital-based training group between baseline and 12 weeks (p =.006 and 0.003, respectively). There was no statistically significant improvement in exercise time as well as subjective and objective assessment ratings over time in the home-based training group. The qualitative data suggested that participants who were randomized to the hospital-based training group wished to have the PLET at home and vice versa. Several participants across groups lacked motivation because of their workload or time constraints, though most believed the COVID-19 pandemic had no influence on their motivation or the time they had for training. Conclusion: The PLET enhances laparoscopic surgical skills over time in a hospital-based training setting. In order to understand and optimize motivational factors, further research is needed. Trial registration: This trial was retrospectively registered on clinicaltrials.gov (NCT06301230). [ABSTRACT FROM AUTHOR]

Background: For high-risk patients receiving right-sided colectomy, stoma formation is a safety strategy. Options are anastomosis with loop ileostomy, end ileostomy, or split stoma. The aim is to compare the outcome of these three options. Methods: This retrospective cohort study included all patients who underwent right sided colectomy and stoma formation between January 2008 and December 2021 at two tertial referral centers in Switzerland. The primary outcome was the stoma associated complication rate within one year. Results: A total of 116 patients were included. A total of 20 patients (17%) underwent primary anastomosis with loop ileostomy (PA group), 29 (25%) received an end ileostomy (ES group) and 67 (58%) received a split stoma (SS group). Stoma associated complication rate was 43% (n = 21) in PA and in ES group and 50% (n = 34) in SS group (n.s.). A total of 30% (n = 6) of patients in PA group needed reoperations, whereas 59% (n = 17) in ES and 58% (n = 39) in SS group had reoperations (P = 0.07). Wound infections occurred in 15% (n = 3) in PA, in 10% (n = 3) in ES, and in 30% (n = 20) in SS group (P = 0.08). A total of 13 patients (65%) in PA, 7 (24%) in ES, and 29 (43%) in SS group achieved stoma closure (P = 0.02). A total of 5 patients (38%) in PA group, 2 (15%) in ES, and 22 patients (67%) in SS group had a stoma-associated rehospitalization (P < 0.01). Conclusion: Primary anastomosis and loop ileostomy may be an option for selected patients. Patients with end ileostomies have fewer stoma-related readmissions than those with a split stoma, but they have a lower rate of stoma closure. Clinical trial registration: Trial not registered. [ABSTRACT FROM AUTHOR]

This study aimed to examine whether acute myocardial infarction (AMI) patients in Switzerland return to work and identify factors associated therewith. Data of 4315 working-age AMI patients enrolled in the Swiss AMIS Plus registry between 01/2006 and 09/2021 with 1-year follow-up and self-reported work status were analyzed. Patient characteristics were compared between those who did not reduce their work hours, those who reduced, and those who were no longer working 1 year after AMI. Multinomial logistic regression was used to analyze independent predictors of working ability. Of the patients, 3204 (74.3%) did not reduce their work hours, 592 (13.7%) reduced and 519 (12.0%) were no longer working 1 year after AMI. Women were more likely to reduce or stop working. Patients who did not reduce were more frequently young and male. Multinomial logistic regression showed that work reduction was associated with female sex and a Killip class > 2 at admission whereas stopping work was associated with female sex and comorbidities. A high rate of AMI patients in Switzerland (88%) return to work 1 year after AMI. Approximately 1 in 8 did not return to work and approximately 1 in 7 reduced their work hours. Important factors associated with reducing or no longer working after AMI were female sex, older age and a higher proportion of comorbidities. [ABSTRACT FROM AUTHOR]

Dynamic face stimuli are increasingly used in face perception research, as increasing evidence shows they are perceived differently from static photographs. One popular method for creating dynamic faces is the dynamic morph, which can animate the transition between expressions by blending two photographs together. Although morphs offer increased experimental control, their unnatural motion differs from the biological facial motion captured in video recordings. This study aimed to compare ratings of emotion intensity and genuineness in video recordings, dynamic morphs, and static photographs of happy, sad, fearful, and angry expressions. We found that video recordings were perceived to have greater emotional intensity than dynamic morphs, and video recordings of happy expressions were perceived as more genuine compared to happy dynamic morphs. Unexpectedly, static photographs and video recordings had similar ratings for genuineness and intensity. Overall, these results suggest that dynamic morphs may be an inappropriate substitute for video recordings, as they may elicit misleading dynamic effects. [ABSTRACT FROM AUTHOR]

Prior research into bystander responses to hate speech has utilized variable-centered analyses — such approaches risk simplifying the complex nature of bystander behaviors. Hence, the present study used a person-centered analysis to investigate latent hate speech bystander profiles. In addition, individual and classroom-level correlates associated with the various profiles were studied. The sample included 3225 students in grades 7–9 (51.7% self-identified as female; 37.2% with immigrant background) from 215 classrooms in Germany and Switzerland. The latent profile analysis revealed that four distinct profiles could be distinguished: Passive Bystanders (34.2%), Defenders (47.3%), Revengers (9.8%), and Contributors (8.6%). Multilevel logistic regression models showed common and distinct correlates. For example, students who believed that certain social groups are superior were more likely to be Revengers and Contributors than Passive Bystanders, students who felt more connected with teachers were more likely to be Defenders, and students who were more open to diversity were less likely to be Contributors than Passive Bystanders. Students were less likely Defenders and more likely Revengers and Contributors than Passive Bystanders in classrooms with high rates of hate speech perpetration. Further, in classrooms with high hate speech intervention, students were more likely to be Defenders and less likely to be Contributors than Passive Bystanders. In classrooms with stronger cohesion, students were more likely to be Defenders and less likely to be Contributors than Passive Bystanders. In conclusion, the findings add to our understanding of bystander profiles concerning racist hate speech and the relevance of individual and classroom-level factors in explaining various profiles of bystander behavior. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to investigate the 2-year postoperative efficacy of the XEN45 Gel Stent by evaluating the reduction of intraocular pressure (IOP) and the need for eye pressure-lowering medications in a multicenter setting in Switzerland. Methods: Patients with various types of glaucoma who received a XEN45 Gel Stent with or without combined phacoemulsification cataract surgery at five hospitals in Switzerland were retrospectively enrolled. Pre- and postoperative IOP, the number of antiglaucoma medications, and the need of subsequent interventions to control IOP were assessed. The success rate was defined as a ≥ 20% reduction of IOP 2 years postoperatively without the need for subsequent glaucoma surgery. Results: A total of 345 eyes were included: 44.3% with primary open-angle, 42.0% pseudoexfoliation, and 13.7% with other types of glaucoma. Of these, 206 patients were followed for 2 years. Preoperatively, the mean IOP was 26.3 ± 8.9 mmHg and the mean number of antiglaucoma medications administered was 3.0 ± 1.3. Two years postoperatively, the success rate was 66.0% (95% confidence interval 59.3–72.1%), the IOP had dropped by 43.8% to 14.8 ± 5.7 mmHg, and the number of medications was reduced by a mean of 2.0 ± 1.7 per day. Postoperative complications and the need for interventions remained low. Conclusion: The XEN45 Gel Stent successfully reduced IOP and the number of antiglaucoma drugs in most patients at 2 years postoperatively. [ABSTRACT FROM AUTHOR]

Background: In primarily unresectable liver tumors, ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy) may offer curative two-stage hepatectomy trough a fast and extensive hypertrophy. However, concerns have been raised about the invasiveness of the procedure. Full robotic ALPPS has the potential to reduce the postoperative morbidity trough a less invasive access. The aim of this study was to compare the perioperative outcomes of open and full robotic ALPPS. Methods: The bicentric study included open ALPPS cases from the University Hospital Zurich, Switzerland and robotic ALPPS cases from the University of Modena and Reggio Emilia, Italy from 01/2015 to 07/2022. Main outcomes were intraoperative parameters and overall complications. Results: Open and full robotic ALPPS were performed in 36 and 7 cases. Robotic ALPPS was associated with less blood loss after both stages (418 ± 237 ml vs. 319 ± 197 ml; P = 0.04 and 631 ± 354 ml vs. 258 ± 53 ml; P = 0.01) as well as a higher rate of interstage discharge (86% vs. 37%; P = 0.02). OT was longer with robotic ALPPS after both stages (371 ± 70 min vs. 449 ± 81 min; P = 0.01 and 282 ± 87 min vs. 373 ± 90 min; P = 0.02). After ALPPS stage 2, there was no difference for overall complications (86% vs. 86%; P = 1.00) and major complications (43% vs. 39%; P = 0.86). The total length of hospital stay was similar (23 ± 17 days vs. 26 ± 13; P = 0.56). Conclusion: Robotic ALPPS was safely implemented and showed potential for improved perioperative outcomes compared to open ALPPS in an experienced robotic center. The robotic approach might bring the perioperative risk profile of ALPPS closer to interventional techniques of portal vein embolization/liver venous deprivation. [ABSTRACT FROM AUTHOR]

Venetoclax is active in both frontline and relapsed/refractory settings for the treatment of chronic lymphocytic leukemia (CLL). Although the prevalence and severity of tumor lysis syndrome (TLS) are well characterized in clinical trials, laboratory and clinical TLS remain relatively unexplored in real-world clinical practice. In this prospective, real-world observational study, we aimed to determine the incidence and outcomes of TLS in patients with CLL receiving venetoclax outside a clinical trial. The study (VeRVe) was conducted in centers in Austria, Germany, and Switzerland. Two hundred and thirty-nine patients were treated according to local label with at least one dose of venetoclax. Patient demographics, baseline characteristics, and blood chemistry at baseline were documented, and descriptive statistical analyses were conducted. Seventy eight patients (33%) were treated with venetoclax monotherapy, 101 (42%) with venetoclax in combination with rituximab and 60 (25%) with venetoclax in combination with obinutuzumab. In all cases, the TLS risk mitigation strategy adhered to the ramp-up protocol. Median age was 73 years and 66% of patients were male. The majority of patients (75%) had relapsed/refractory CLL, 63/192 (32.8%) patients tested had a del(17p) and 93/134 (69.4%) patients tested had unmutated immunoglobulin heavy chain variable region gene (IGHV). Clinical TLS occurred in 5 patients (2.1%) and laboratory TLS occurred in 15 patients (6.3%). Ten patients received specific treatment, of which 6 were hospitalized. There were no deaths due to a TLS event and venetoclax was well-tolerated. Of the 5 clinical TLS events reported, none were fatal or resulted in renal failure (NCT03342144, registered on Nov 10, 2017). [ABSTRACT FROM AUTHOR]

Klebsiella pneumoniae releases the peptides AKTIKITQTR and FNEMQPIVDRQ, which bind the pneumococcal proteins AmiA and AliA respectively, two substrate-binding proteins of the ABC transporter Ami-AliA/AliB oligopeptide permease. Exposure to these peptides alters pneumococcal phenotypes such as growth. Using a mutant in which a permease domain of the transporter was disrupted, by growth analysis and epifluorescence microscopy, we confirmed peptide uptake via the Ami permease and intracellular location in the pneumococcus. By RNA-sequencing we found that the peptides modulated expression of genes involved in metabolism, as pathways affected were mostly associated with energy or synthesis and transport of amino acids. Both peptides downregulated expression of genes involved in branched-chain amino acid metabolism and the Ami permease; and upregulated fatty acid biosynthesis genes but differed in their regulation of genes involved in purine and pyrimidine biosynthesis. The transcriptomic changes are consistent with growth suppression by peptide treatment. The peptides inhibited growth of pneumococcal isolates of serotypes 3, 8, 9N, 12F and 19A, currently prevalent in Switzerland, and caused no detectable toxic effect to primary human airway epithelial cells. We conclude that pneumococci take up K. pneumoniae peptides from the environment via binding and transport through the Ami permease. This changes gene expression resulting in altered phenotypes, particularly reduced growth. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective study aims to describe anatomical parameters of omphaloceles and to analyze their association with anatomical, genetic, or syndromic malformations. Methods: Cases were selected from digital records of two university centers, a certified regional registry and personal records. Patients from 1998 to 2018 with omphalocele and live birth (LB), termination of pregnancy due to fetal anomaly (TOPFA) and fetal death (FD) were included. Cases born outside Western Switzerland and/or with upper or lower coelosomy were excluded. Results: We analyzed 162 cases with the following distribution: 57 (35%) LB, 91 (56%) TOPFA and 14 (9%) FD. TOPFA was significantly more frequently performed in cases with non-isolated omphalocele, i.e., omphaloceles with associated major malformations (especially cardiovascular and genitourinary), genetic/chromosomal anomalies, or syndromes. For LB, associated anatomical malformations, genetic or chromosomal anomalies were not significantly associated with the size of the omphalocele or the liver involvement. Conclusions: The proportion of cases resulting in TOPFA was higher among fetuses with major malformations, genetic or chromosomal anomalies. Despite the large size of this cohort, and in contrary to previous publications, the size of the omphalocele and/or liver involvement does not allow for conclusions regarding the presence or number of associated malformations, genetic or chromosomal anomalies. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic was associated with a decrease in emergency department (ED) visits. However, contradictory, and sparse data regarding children could not yet answer the question, how pediatric ED utilization evolved throughout the pandemic. Our objectives were to investigate the impact of the pandemic in three language regions of Switzerland by analyzing trends over time, describe regional differences, and address implications for future healthcare. Methods: We conducted a retrospective, longitudinal cohort study at three Swiss tertiary pediatric EDs (March 1st, 2018—February 28th, 2022), analyzing the numbers of ED visits (including patients' age, triage categories, and urgent vs. non-urgent cases). The impact of COVID-19 related non-pharmaceutical interventions (NPIs) on pediatric ED utilization was assessed by interrupted time series (ITS) modelling. Results: Based on 304′438 ED visits, we found a drop of nearly 50% at the onset of NPIs, followed by a gradual recovery. This primarily affected children 0–4 years, and both non-urgent and urgent cases. However, the decline in urgent visits appeared to be more pronounced in two centers compared to a third, where also hospitalization rates did not decrease significantly during the pandemic. A subgroup analysis showed a significant decrease in respiratory and gastrointestinal diseases, and an increase in the proportion of trauma patients during the pandemic. Conclusions: The COVID-19 pandemic had substantial effects on number and reasons for pediatric ED visits, particularly among children 0–4 years. Despite equal regulatory conditions, the utilization dynamics varied markedly between the three regions, highlighting the multifactorial modification of pediatric ED utilization during the pandemic. Furthermore, future policy decisions should take regional differences into account. [ABSTRACT FROM AUTHOR]

Summary: Number and age-standardized incidences of femoral fractures by sex and localization were determined annually between 1998 and 2021 in subjects aged 45 years or older living in Switzerland. The number and incidences of femoral neck, pertrochanteric, subtrochanteric, and femoral shaft fractures followed distinct unexpected trend patterns. Introduction: Long-term incidence trends for femoral fractures by individual localizations are unknown. Methods: Annual absolute number of hospitalizations and median age at hospital admission between 1998 and 2021 were extracted from the medical database of the Swiss Federal Office of Statistics by sex and 10-year age groups for the following 10th International Classification of Diseases (ICD-10) codes: femoral neck (ICD-10 S72.0), pertrochanteric (S72.1), subtrochanteric (S72.2), and femoral shaft fractures (S72.3). Age-standardized incidence rates (ASI) and corresponding trends were calculated. Results: Over 24 years, the number of femoral neck fractures increased in men (+ 45%) but decreased in women (− 7%) with ASI significantly decreasing by 20% and 37% (p < 0.001 for trend for both), respectively. By contrast, the number of pertrochanteric fractures increased by 67% and 45% in men and women, respectively, corresponding to a horizontal ASI-trend in men (n.s.) and a modest significant decreasing ASI-trend in women (p < 0.001). The number of subtrochanteric fractures increased in both sexes with corresponding modest significant reductions in ASI-trends (p = 0.015 and 0.002, respectively). Femoral shaft fractures almost doubled in men (+ 71%) and doubled in women (+ 100%) with corresponding significant increases in ASI-trends (p = 0.001 and p < 0.001, respectively). Age at admission increased for all fracture localizations, more so in men than in women and more so for subtrochanteric and shaft fractures than for "typical" hip fractures. Conclusion: Incidence changes of pertrochanteric fractures and femoral shaft fractures deserve increased attention, especially in men. Pooling diagnostic codes for defining hip fractures may hide differing patterns by localization and sex. [ABSTRACT FROM AUTHOR]

Understanding health-related quality of life (HRQOL) in children and adolescents, during a pandemic and afterwards, aids in understanding how circumstances in their lives impact their well-being. We aimed to identify determinants of HRQOL from a broad range of biological, psychological, and social factors in a large longitudinal population-based sample. Data was taken from a longitudinal sample (n = 1843) of children and adolescents enrolled in the prospective school-based cohort study Ciao Corona in Switzerland. The primary outcome was HRQOL, assessed using the KINDL total score and its subscales (each from 0, worst, to 100, best). Potential determinants, including biological (physical activity, screen time, sleep, etc.), psychological (sadness, anxiousness, stress), and social (nationality, parents' education, etc.) factors, were assessed in 2020 and 2021 and HRQOL in 2022. Determinants were identified in a data-driven manner using recursive partitioning to define homogeneous subgroups, stratified by school level. Median KINDL total score in the empirically identified subgroups ranged from 68 to 83 in primary school children and from 69 to 82 in adolescents in secondary school. The psychological factors sadness, anxiousness, and stress in 2021 were identified as the most important determinants of HRQOL in both primary and secondary school children. Other factors, such as physical activity, screen time, chronic health conditions, or nationality, were determinants only in individual subscales. Conclusion: Recent mental health, more than biological, physical, or social factors, played a key role in determining HRQOL in children and adolescents during pandemic times. Public health strategies to improve mental health may therefore be effective in improving HRQOL in this age group. What is Known: • Assessing health-related quality of life (HRQOL) in children and adolescents aids in understanding how life circumstances impact their well-being. • HRQOL is a complex construct, involving biological, psychological, and social factors. Factors driving HRQOL in children and adolescents are not often studied in longitudinal population-based samples. What is New: • Mental health (stress, anxiousness, sadness) played a key role in determining HRQOL during the coronavirus pandemic, more than biological or social factors. • Public health strategies to improve mental health may be effective in improving HRQOL in children. [ABSTRACT FROM AUTHOR]

Forensic anthropology (FA) as a specialized discipline has been practised in multi-lingual Switzerland for over a decade. A variety of expertise regarding osteological assessments as well as facial image comparison (FIC) is provided by different centres. Nevertheless, information is lacking about the awareness of FA and its benefits for forensic investigations among forensic stakeholders. Therefore, a survey was sent to Swiss anthropologists (AN) and related professions (police officers, prosecutors, and forensic pathologists) to assess three main aspects: (1) the experience of working (biological/forensic) anthropologists within FA; (2) how FA is perceived by other professions within the legal system; and (3) identify gaps (if any) in understanding of FA with the aim to suggest avenues for improvement if necessary. The results show that awareness of FA varies by occupation and cantonal regions. In areas where close collaborations between forensic anthropologists (FAs) and other stakeholders have been formally established, be it with focus on osteological analyses or FIC, the awareness of FA competencies was superior to areas where this was not the case. An overwhelming majority of forensic actors expressed interest in continuing education related to the role of FA. These findings indicate that facilitation of communication and collaboration leads to improvement in the awareness of the competencies of FAs and their contribution to forensic investigations. [ABSTRACT FROM AUTHOR]

Introduction: Older adults and patients with underlying conditions such as immunocompromised (IC) populations (e.g., due to medical conditions or immunosuppressive medication) are at increased risk for herpes zoster (HZ). The first HZ recombinant vaccine for IC patients was approved in 2020. Limited evidence exists to inform decision-makers on HZ incidence in high-risk patients in Europe. This systematic literature review (SLR) assessed HZ incidence across 14 high-risk populations in the European Union/European Economic Area, Switzerland, and the United Kingdom. Methods: An SLR (Embase, Medline, 2002–2022, observational studies) was performed to identify HZ incidence (i.e., primary outcomes: rate or cumulative; secondary: relative incidence) in type 1 and 2 diabetes mellitus (DM); chronic obstructive pulmonary disease and asthma; depression; rheumatic disorders (RD); multiple sclerosis (MS); inflammatory bowel diseases (IBD); psoriasis; lupus; human immunodeficiency virus (HIV); solid organ transplantation (SOT); solid organ malignancy (SOM); hematologic malignancy (HM); and stem cell transplantation (SCT). Results: Of 776 unique records screened, 59 studies were included (24 reported incidence rate per 1000 person-years; two, cumulative incidence per 1000 persons; and 33, relative incidence). The highest incidence rates were reported for SOT (12.1–78.8) and SCT (37.2–56.1); HM (2.9–32.0); RD (0.41–21.5); lupus (11.0–16.5); IC mixed population (11.3–15.5); HIV/AIDS (11.8–13.0); chronic respiratory diseases (4.7–11.4); SOM (8.8–11.0); IBD (7.0–10.8); DM (4.3–9.4); depression (7.2–7.6); MS (5.7–6.3); and psoriasis (5.3–6.1). In many high-risk populations, HZ incidence was higher for older age groups, women, and some treatments. Conclusions: The HZ incidence rate in Europe increased with age and varied across high-risk populations, with high rates for solid organ and stem cell transplants, cancer, and rheumatoid arthritis. Most studies were retrospective with methodological differences affecting generalizability and comparability. Future studies should stratify data by IC population, age, sex, severity, medication, and study timeframe. [ABSTRACT FROM AUTHOR]

Newborn screening for 5qSMA offers the potential for early, ideally pre-symptomatic, therapeutic intervention. However, limited data exist on the outcomes of individuals with 4 copies of SMN2, and there is no consensus within the SMA treatment community regarding early treatment initiation in this subgroup. To provide evidence-based insights into disease progression, we performed a retrospective analysis of 268 patients with 4 copies of SMN2 from the SMArtCARE registry in Germany, Austria and Switzerland. Inclusion criteria required comprehensive baseline data and diagnosis outside of newborn screening. Only data prior to initiation of disease-modifying treatment were included. The median age at disease onset was 3.0 years, with a mean of 6.4 years. Significantly, 55% of patients experienced symptoms before the age of 36 months. 3% never learned to sit unaided, a further 13% never gained the ability to walk independently and 33% of ambulatory patients lost this ability during the course of the disease. 43% developed scoliosis, 6.3% required non-invasive ventilation and 1.1% required tube feeding. In conclusion, our study, in line with previous observations, highlights the substantial phenotypic heterogeneity in SMA. Importantly, this study provides novel insights: the median age of disease onset in patients with 4 SMN2 copies typically occurs before school age, and in half of the patients even before the age of three years. These findings support a proactive approach, particularly early treatment initiation, in this subset of SMA patients diagnosed pre-symptomatically. However, it is important to recognize that the register will not include asymptomatic individuals. [ABSTRACT FROM AUTHOR]

Backgound: Hyperoxemia is common and associated with poor outcome during veno-arterial extracorporeal membrane oxygenation (VA ECMO) support for cardiogenic shock. However, little is known about practical daily management of oxygenation. Then, we aim to describe sweep gas oxygen fraction (FSO2), postoxygenator oxygen partial pressure (PPOSTO2), inspired oxygen fraction (FIO2), and right radial arterial oxygen partial pressure (PaO2) between day 1 and day 7 of peripheral VA ECMO support. We also aim to evaluate the association between oxygenation parameters and outcome. In this retrospective multicentric study, each participating center had to report data on the last 10 eligible patients for whom the ICU stay was terminated. Patients with extracorporeal cardiopulmonary resuscitation were excluded. Primary endpoint was individual mean FSO2 during the seven first days of ECMO support (FSO2mean (day 1−7)). Results: Between August 2019 and March 2022, 139 patients were enrolled in 14 ECMO centers in France, and one in Switzerland. Among them, the median value for FSO2mean (day 1−7) was 70 [57; 79] % but varied according to center case volume. Compared to high volume centers, centers with less than 30 VA-ECMO runs per year were more likely to maintain FSO2 ≥ 70% (OR 5.04, CI 95% [1.39; 20.4], p = 0.017). Median value for right radial PaO2mean (day 1−7) was 114 [92; 145] mmHg, and decreased from 125 [86; 207] mmHg at day 1, to 97 [81; 133] mmHg at day 3 (p < 0.01). Severe hyperoxemia (i.e. right radial PaO2 ≥ 300 mmHg) occurred in 16 patients (12%). PPOSTO2, a surrogate of the lower body oxygenation, was measured in only 39 patients (28%) among four centers. The median value of PPOSTO2mean (day 1−7) value was 198 [169; 231] mmHg. By multivariate analysis, age (OR 1.07, CI95% [1.03–1.11], p < 0.001), FSO2mean (day 1−3)(OR 1.03 [1.00-1.06], p = 0.039), and right radial PaO2mean (day 1−3) (OR 1.03, CI95% [1.00-1.02], p = 0.023) were associated with in-ICU mortality. Conclusion: In a multicentric cohort of cardiogenic shock supported by VA ECMO, the median value for FSO2mean (day 1−7) was 70 [57; 79] %. PPOSTO2 monitoring was infrequent and revealed significant hyperoxemia. Higher FSO2mean (day 1−3) and right radial PaO2mean (day 1−3) were independently associated with in-ICU mortality. [ABSTRACT FROM AUTHOR]

X-rays have been observed in natural downward cloud-to-ground lightning for over 20 years and in rocket-triggered lightning for slightly less. In both cases, this energetic radiation has been detected during the stepped and dart leader phases of downward negative flashes. More recently, X-rays have also been reported during the dart leader phase of upward negative flashes. In this study, we present the observations of four upward positive lightning flashes from the Säntis Tower (2.5 km ASL) in Switzerland. These consist of the simultaneous records of electric current passing through the tower, and electric field strength and X-ray flux 20 m from the tower base. One of the flashes was captured by a high-speed camera operating at 24,000 frames per second, stills from which are also presented. We detected X-rays during the initial phase of upward negative leader propagation, which can be associated with the leader-stepping process from electric field and current waveforms. To the best of our knowledge, this is the first time that such measurements are reported in the literature. The obtained time-synchronised data confirm that the X-ray emissions detected are associated with the initial steps of the upward negative leader. The frequency and energy of X-ray pulses appear to decrease as functions of time, with pulses disappearing altogether within the first millisecond of the leader initiation. X-ray emission also appears to be correlated with the maximum current-derivative and the electric field change of leader steps, consistent with cold electron runaway. These observations contribute to improving our understanding of upward lightning, which is a primary source of damage to tall structures such as wind turbines and telecommunications towers, as well as aircraft during takeoff and landing. [ABSTRACT FROM AUTHOR]

Purpose: Depression is associated with low-grade systemic inflammation and impaired intestinal function, both of which may reduce dietary iron absorption. Low iron status has been associated with depression in adults and adolescents. In Swiss adolescents, we determined the associations between paediatric major depressive disorder (pMDD), inflammation, intestinal permeability and iron status. Methods: This is a matched case–control study in 95 adolescents with diagnosed pMDD and 95 healthy controls aged 13–17 years. We assessed depression severity using the Children's Depression Rating Scale-Revised. We measured iron status (serum ferritin (SF) and soluble transferrin receptor (sTfR)), inflammation (C-reactive protein (CRP) and alpha-1-acid-glycoprotein (AGP)), and intestinal permeability (intestinal fatty acid binding protein (I-FABP)). We assessed history of ID diagnosis and treatment with a self-reported questionnaire. Results: SF concentrations did not differ between adolescents with pMDD (median (IQR) SF: 31.2 (20.2, 57.0) μg/L) and controls (32.5 (22.6, 48.3) μg/L, p = 0.4). sTfR was lower among cases than controls (4.50 (4.00, 5.50) mg/L vs 5.20 (4.75, 6.10) mg/L, p < 0.001). CRP, AGP and I-FABP were higher among cases than controls (CRP: 0.16 (0.03, 0.43) mg/L vs 0.04 (0.02, 0.30) mg/L, p = 0.003; AGP: 0.57 (0.44, 0.70) g/L vs 0.52 (0.41, 0.67) g/L, p = 0.024); I-FABP: 307 (17, 515) pg/mL vs 232 (163, 357) pg/mL, p = 0.047). Of cases, 44% reported having a history of ID diagnosis compared to 26% among controls (p = 0.020). Finally, 28% of cases had iron treatment at/close to study inclusion compared to 14% among controls. Conclusion: Cases had significantly higher systemic inflammation and intestinal permeability than controls but did not have lower iron status. Whether this is related to the higher rate of ID diagnosis and iron treatment in adolescents with depression is uncertain. [ABSTRACT FROM AUTHOR]

Orthoconic cephalopods are subordinate, but persistent, widespread and regionally abundant components of Triassic marine ecosystems. Here, we describe unpublished specimens from the Anisian (Middle Triassic) Besano Formation at Monte San Giorgio, Switzerland. They can be assigned to two major but unrelated lineages, the Coleoidea and the Orthoceratoidea. The orthoceratoids belong to Trematoceras elegans (Münster, 1841) and occur regularly within the Besano Formation, are uniform in size, and have few available morphological characters. In contrast, coleoids are more diverse and appear to be restricted to shorter intervals. A new coleoid is described as Ticinoteuthis chuchichaeschtli gen. et sp. nov. To better put the orthoceratoids of the Besano Formation into perspective, we also synthesise the current taxonomy of Triassic orthoceratoids on a global scale. The currently used scheme is largely outdated, with very little taxonomic progress in the past 100 years. Despite previous research showing the distinctness of Triassic orthoceratoids from Palaeozoic taxa, they are still commonly labelled as "Orthoceras" or "Michelinoceras", which are confined to the Palaeozoic. We show that Triassic orthoceratoids probably belong to a single lineage, the Trematoceratidae, which can be assigned to the Pseudorthocerida based on the embryonic shell and endosiphuncular deposits. Many Triassic species can probably be assigned to Trematoceras, but there are at least two additional Triassic orthoceratoid genera, Paratrematoceras and Pseudotemperoceras. Finally, we review the palaeobiogeographic and stratigraphic distribution of the group and outline possible future research directions. [ABSTRACT FROM AUTHOR]

This article relies on quantitative data collected in Switzerland as part of a research study on sexual transactions among youth. Building on an analytical framework that defines sexual transactions in terms of negotiated exchanges rooted in social representations, we explored how they were perceived by the Swiss young people included in our sample at a cognitive, ethical, and political level. We found that research participants who reported having experienced sexual transactions viewed them much more positively than those who reported never having engaged in such exchanges. While this was especially true among young women, we also found that the tendency of respondents to perceive sexual transactions negatively increased with age. When analyzed in light of the qualitative results of our study, these quantitative findings suggest that negative representations of sexual transactions are less likely to be based on lived experience than on an ideal-type of sexual behavior. In other words, our research highlights how young people interpret sexuality according to norms developed within a heteronormative matrix. [ABSTRACT FROM AUTHOR]

Eplontersen (Wainua™) is a ligand-conjugated antisense oligonucleotide directed to TTR, which is being developed by Ionis Pharmaceuticals and AstraZeneca for the treatment of TTR-mediated amyloidosis (ATTR). Eplontersen, which is targeted to the liver by a ligand containing three N-acetyl galactosamine residues, binds to wild-type and variant TTR mRNA, thus reducing the levels of circulating TTR protein and amyloid deposition. Subcutaneous eplontersen reduced serum TTR levels, inhibited neuropathy progression and improved health-related quality of life in patients with polyneuropathy of hereditary ATTR (ATTRv-PN; v for variant) in a phase III trial. Based on these results, eplontersen was approved in the USA for the treatment of ATTRv-PN on 21 December 2023 and is currently undergoing regulatory review for a similar indication in the EU, the UK, Switzerland and Canada. Eplontersen is also undergoing phase III development for ATTR cardiomyopathy. This article summarizes the milestones in the development of eplontersen leading to this first approval for ATTRv-PN. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess a potential organ protective effect of volatile sedation in a scenario of severe inflammation with an early cytokine storm (in particular IL-6 elevation) in patients suffering from COVID-19-related lung injury with invasive mechanical ventilation and sedation. Methods: This is a small-scale pilot multicenter randomized controlled trial from four tertiary hospitals in Switzerland, conducted between April 2020 and May 2021. 60 patients requiring mechanical ventilation due to severe COVID-19-related lung injury were included and randomized to 48-hour sedation with sevoflurane vs. continuous intravenous sedation (= control) within 24 h after intubation. The primary composite outcome was determined as mortality or persistent organ dysfunction (POD), defined as the need for mechanical ventilation, vasopressors, or renal replacement therapy at day 28. Secondary outcomes were the length of ICU and hospital stay, adverse events, routine laboratory parameters (creatinine, urea), and plasma inflammatory mediators. Results: 28 patients were randomized to sevoflurane, 32 to the control arm. The intention-to-treat analysis revealed no difference in the primary endpoint with 11 (39%) sevoflurane and 13 (41%) control patients (p = 0.916) reaching the primary outcome. Five patients died within 28 days in each group (16% vs. 18%, p = 0.817). Of the 28-day survivors, 6 (26%) and 8 (30%) presented with POD (p = 0.781). There was a significant difference regarding the need for vasopressors (1 (4%) patient in the sevoflurane arm, 7 (26%) in the control one (p = 0.028)). Length of ICU stay, hospital stay, and registered adverse events within 28 days were comparable, except for acute kidney injury (AKI), with 11 (39%) sevoflurane vs. 2 (6%) control patients (p = 0.001). The blood levels of IL-6 in the first few days after the onset of the lung injury were less distinctly elevated than expected. Conclusions: No evident benefits were observed with short sevoflurane sedation on mortality and POD. Unexpectedly low blood levels of IL-6 might indicate a moderate injury with therefore limited improvement options of sevoflurane. Acute renal issues suggest caution in using sevoflurane for sedation in COVID-19. Trial registration: The trial was registered on ClinicalTrials.gov (NCT04355962) on 2020/04/21. [ABSTRACT FROM AUTHOR]

During the re-mapping of the area for the Geological Atlas of Switzerland, a significant stratigraphic unconformity was discovered in the North Penninic (Valais) Bündnerschiefer and the Flysch series of the northern Prättigau. It separates different units of the Cretaceous Bündnerschiefer from the Palaeogene Flysch. We explain this observation by a basin conversion from extension to compression, which caused the initial deformation of the Bündnerschiefer in an accretionary wedge. Interlinked return-flow has created a new heterogeneous substrate for the flysch sediments and explains the different types of unconformities. The basin conversion coincided with high-grade metamorphism in the vicinity of the the South Penninic suture and the Austroalpine units, and the increased exhumation in the Austroalpine nappe stack. Detrital zircon dating confirms also a change from European to Austroalpine detrital sources in the flysch sandstones. We discuss a palaeotectonic model leading to hP/lT metamorphism of the Bündnerschiefer in the Late Eocene (c. 42 Ma). It appears that the flysch formations were also involved, but to a lesser degree by tectonic deformation from the late Early Eocene onwards, as the pervasive folding characteristic of the Bündnerschiefer is absent. This has been followed by a phase of S-directed backfolding. During the Oligocene and Miocene, more extensive deformation occurred by SE to NW compression and finally by probable westward thrusting and folding. Our main theme is the transition from passive to active continental margins, which in Alpine plate tectonic framework corresponds to the transition to flysch sedimentation by basin conversion. Our results show that the simultaneity of the transition from extension to compression, as indicated by the accumulation of flysch, shifted in time from south to north in the Alpine Tethys. [ABSTRACT FROM AUTHOR]

DNA barcoding is an essential tool in modern biodiversity sciences. Despite considerable work to barcode the tree of life, many groups, including insects, remain partially or totally unreferenced, preventing barcoding from reaching its full potential. Aquatic insects, especially the three orders Ephemeroptera, Plecoptera, and Trichoptera (EPT), are key freshwater quality indicators worldwide. Among them, Plecoptera (stoneflies), which are among the most sensitive aquatic insects to habitat modification, play a central role in river monitoring surveys. Here, we present an update of the Plecoptera reference database for (meta)barcoding in Switzerland, now covering all 118 species known from this country. Fresh specimens, mostly from rare or localized species, were collected, and 151 new CO1 barcodes were generated. These were merged with the 422 previously published sequences, resulting in a dataset of 573 barcoded specimens. Our CO1 dataset was delimited in 115 CO1 clusters based on a priori morphological identifications, of which 17% are newly reported for Switzerland, and 4% are newly reported globally. Among the 115 CO1 clusters, 85% showed complete congruence with morphology. Distance-based analysis indicated local barcoding gaps in 97% of the CO1 clusters. This study significantly improves the Swiss reference database for stoneflies, enhancing future species identification accuracy and biodiversity monitoring. Additionally, this work reveals cryptic diversity and incongruence between morphology and barcodes, both presenting valuable opportunities for future integrative taxonomic studies. Voucher specimens, DNA extractions and reference barcodes are available for future developments, including metabarcoding and environmental DNA surveys. [ABSTRACT FROM AUTHOR]

In Hungary, as part of a nationwide, climatically balanced survey for a next-generation sequencing-based study of the honey bee (Apis mellifera) gut microbiome, repeated sampling was carried out during the honey production season (March and May 2019). Among other findings, the presence of Apis mellifera filamentous virus (AmFV) was detected in all samples, some at very high levels. AmFV-derived reads were more abundant in the March samples than in the May samples. In March, a higher abundance of AmFV-originated reads was identified in samples collected from warmer areas compared to those collected from cooler areas. A lower proportion of AmFV-derived reads were identified in samples collected in March from the wetter areas than those collected from the drier areas. AmFV-read abundance in samples collected in May showed no significant differences between groups based on either environmental temperature or precipitation. The AmFV abundance correlated negatively with Bartonella apihabitans, Bartonella choladocola, and positively with Frischella perrara, Gilliamella apicola, Gilliamella sp. ESL0443, Lactobacillus apis, Lactobacillus kullabergensis, Lactobacillus sp. IBH004. De novo metagenome assembly of four samples resulted in almost the complete AmFV genome. According to phylogenetic analysis based on DNA polymerase, the Hungarian strains are closest to the strain CH-05 isolated in Switzerland. [ABSTRACT FROM AUTHOR]

Purpose: The Swiss voluntary salt iodisation programme has successfully prevented iodine deficiency for 100 years, but dietary habits are changing and today only one-third of processed foods contain iodised salt. We aimed to monitor the current iodine status in children and pregnant women. Methods: We conducted a nationwide cross-sectional study in children (6–12 years) and pregnant women and measured the urinary iodine concentration (UIC) in spot urine samples. We estimated the iodine intake using UIC and urinary creatinine concentration (UCC) and determined the prevalence of intakes below the average requirement (AR) using the SPADE method. We measured dried blood spot (DBS) thyroglobulin (Tg), TSH and total T4 in pregnant women. Results: The median UIC was 127 μg/L (bootstrapped 95% CI 119, 140, n = 362) in children and 97 μg/L (bootstrapped 95% CI 90, 106, n = 473) in pregnant women. The estimated prevalence of inadequate iodine intake (< 65 μg/day) was 5.4% (bootstrapped 95% CI 0.0, 14.6) in children. Half (47%) of the women consumed iodine-containing multivitamin and mineral supplements (≥ 150 μg/day). Compared to non-users, users had higher median UIC (129 vs. 81 μg/L, P < 0.001), lower prevalence of inadequacy (< 160 μg/day; 0.2 vs. 31%) and lower DBS-Tg (23 vs. 29 μg/L, P < 0.001). All women were euthyroid. Conclusions: The Swiss diet and current salt fortification provides adequate iodine intake in children, but not in all pregnant women. Iodine supplements cover the dietary gap in pregnancy but are not universally consumed. Therefore, improved use of iodised salt in processed foods is desired to ensure adequate iodine intake in all population groups. This trial was registered at clinicaltrials.gov as NCT04524013. [ABSTRACT FROM AUTHOR]

Purpose: Community-based participatory research (CBPR) that improves social capital can be a powerful tool for promoting mental health and well-being. This work explores what gaining, maintaining, and losing access to this type of CBPR looks like from a reflexive research perspective. Method: I describe and reflect on my experiences conducting a mixed-methods study of an existing CBPR to increase social capital in Switzerland. I draw on ethnographic observations, field notes, and reflexive memos collected during fieldwork between 2016 and 2020. Results: I negotiated access to the CBPR across three levels: (1) formal organizational with intervention leaders, (2) implementational with facilitators, and (3) the community/group level with participants. Intervention leaders let me conduct research if they benefitted from my work in a timely and reinforcing way, facilitators granted access if I made myself helpful and supported their work, and community members accepted me if I participated in their community meaningfully. I lost access when my findings posed a potential risk to the intervention funding. Conclusion: I highlight how access is a fluid and complex process that can change throughout CBPR. I show the importance of reflexive analysis to understand how access is negotiated in diverse settings, what sources of social capital are needed to engage in these negotiations, and how positionality and power play a role in this process. [ABSTRACT FROM AUTHOR]

Little information is available about the nature of the immune response in children after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or vaccination. The aim of this study is to define the seroprevalence and the features of the antibody response in children of Southern Switzerland during the different waves of Coronavirus Disease 2019 (COVID-19) pandemic. By analyzing 756 sera collected from children aged 0 to 16 years admitted to the Institute of Pediatrics of Southern Switzerland during the prepandemic period (before March 2020) and the first four pandemic waves (between March 2020 and June 2022), we investigated binding titers, cross-reactivity, and neutralizing properties of the serum antibodies against SARS-CoV-2 variants. Seroprevalence varied from 6% during the first wave to 14% and 17% during the second and third waves, respectively, peaking at 39% during the fourth wave. The 96 seropositive cases were mostly asymptomatic (42.7%) or showed mild (20.8%) to moderate (32.3%) symptoms. Moderate symptoms and close contact with COVID-19-positive individuals were associated with a higher infection risk (P < 0.001). The antibody response was mainly driven by IgG directed to the receptor-binding domain (RBD) of Wuhan-1 SARS-CoV-2 Spike (S). Children infected in the first three waves produced antibodies with up to 11-fold and 5.5-fold reduction in binding and neutralizing titers, respectively, against different SARS-CoV-2 variants, including Beta, Delta, and Omicron BA.1, BA.2, and BA.5. Such reductions were less pronounced in children infected during the fourth wave, who showed the highest frequency and titers of neutralizing antibodies against the same variants. Compared to infection, vaccination with a Wuhan-1-based messenger RNA (mRNA) vaccine induced higher and heterogenous levels of antibodies cross-reacting to the different SARS-CoV-2 variants analyzed. Conclusions: Despite the high burden of COVID-19 in Southern Switzerland, we observed an initial low seroprevalence of SARS-CoV-2 in children, which increased in the later waves. The antibody response was poor in the first three waves and improved in the fourth wave, when children produced higher levels of neutralizing antibodies after vaccination or infection with Delta and/or Omicron variants. What is Known: • Children were marginally affected by the initial SARS-CoV-2 variants. • The number of infected and hospitalized children increased after the appearance of the Omicron variants. What is New: • Seroprevalence of SARS-CoV-2 in children of Southern Switzerland increased overtime. • Children produced higher levels of neutralizing antibodies after vaccination or infection with Delta and/or Omicron variants in the fourth wave compared to children infected in the first three waves. [ABSTRACT FROM AUTHOR]

Introduction: Real-world data provide insight into how medications perform in clinical practice. The PIONEER REAL Switzerland study aimed to understand clinical outcomes with oral semaglutide in adults with type 2 diabetes (T2D). Methods: PIONEER REAL Switzerland was a 34–44-week, multicentre, prospective, non-interventional, single-arm study of adults with T2D naïve to injectable glucose-lowering medication who were initiated on oral semaglutide in routine clinical practice. The primary endpoint was change in glycated haemoglobin (HbA1c) from baseline (BL) to end of study (EOS); secondary endpoints included change in body weight (BW) from BL to EOS and the proportion of participants achieving HbA1c < 7.0% and the composite endpoints HbA1c reduction ≥ 1%-points with BW reduction ≥ 3% or ≥ 5% at EOS. Safety was assessed in participants who received ≥ 1 dose of oral semaglutide. Results: Of the 185 participants (female/male, n = 67/118) initiating oral semaglutide, 168 (90.8%) completed the study and 143 (77.3%) remained on treatment with oral semaglutide at EOS. At BL, participants had a mean age of 62 years, diabetes duration of 6.4 years, HbA1c of 7.7%, BW of 95.6 kg and body mass index of 33.2 kg/m2; 56.2% of participants were receiving glucose-lowering medications. Significant reductions were observed for HbA1c (estimated change − 0.91%; 95% confidence interval [CI] − 1.10, − 0.71; p < 0.0001) and BW (estimated change − 4.85%; 95% CI − 5.70, − 4.00; p < 0.0001). In total, 139 adverse events (AEs) were reported in 65 (35.1%) participants; most were mild or moderate. The most frequent AEs were gastrointestinal disorders (27.0%); 31 AEs in 20 (10.8%) participants led to discontinuation of oral semaglutide. Six serious AEs were reported; all were considered unlikely to be related to oral semaglutide. Conclusion: People living with T2D treated with oral semaglutide in Switzerland achieved clinically significant reductions in HbA1c and BW, with no new safety signals. Clinical Trial Registration: ClinicalTrials.gov: NCT04537624. A graphical abstract is available for this article. [ABSTRACT FROM AUTHOR]

Environments have a modifying effect on the participation of children and adolescents with autism spectrum disorder (ASD) in all areas of life. This cross-sectional study investigated parental perspectives on supportive or hindering environments and the daily contextual strategies parents used to enhance their children's participation. Qualitative and quantitative data gathered from 115 parents from German-speaking Switzerland using the participation and environment measure-child and youth (PEM-CY) were analyzed. Results revealed 45 environmental supports and barriers at home, at school, and in the community. Contextual strategies were identified in combination with people, activities, time, objects, and places. Parental perspectives on participation and their contextual strategies should be considered in environmental-based interventions to support the participation of children and adolescents with ASD. [ABSTRACT FROM AUTHOR]

As the fourth most prevalent food crop, potato is very important in the global economy, but it is affected by numerous pests, and by many bacterial, viral and fungal diseases. Among these diseases, potato virus Y (PVY), which is transmitted from plant to plant by aphids, causes significant yield losses, but as far as we know, the economic impact of PVY in Europe has not been quantified. Our economic study covers a period of 13 years between 2004 and 2017 and is based on an analysis of statistical, economic and agronomic data, obtained from various stakeholders in the potato sector in Switzerland and the European Union, as well as from field experiments. In Switzerland, the economic loss due to PVY for seed and ware production was estimated at about 2000 and 200 CHF/ha, respectively. For the European Union, the annual losses were estimated at 187 M EUR, respectively 96 and 91 M EUR for seed and ware. These losses were due mainly to the cost of chemical treatments applied in seed potato production and the yield drop in ware potato production. However, based on literature, these significant losses are lower than those caused by potato late blight (Phytophthora infestans), which is considered to be the most economically damaging potato disease in Europe. [ABSTRACT FROM AUTHOR]

Rising air temperatures threaten the snow reliability of ski resorts. Most resorts rely on technical snowmaking to compensate lacking natural snow. But increased water consumption for snowmaking may cause conflicts with other sectors' water uses such as hydropower production or the hotel industry. We assessed the future snow reliability (likelihood of a continuous 100-day skiing season and of operable Christmas holidays) of the Swiss resort Andermatt-Sedrun-Disentis throughout the twenty-first century, where 65% of the area is currently equipped for snowmaking. Our projections are based on the most recent climate change scenarios for Switzerland (CH2018) and the model SkiSim 2.0 including a snowmaking module. Unabated greenhouse gas emissions (scenario RCP8.5) will cause a lack of natural snow at areas below 1800–2000 m asl by the mid-twenty-first century. Initially, this can be fully compensated by snowmaking, but by the end of the century, the results become more nuanced. While snowmaking can provide a continuous 100-day season throughout the twenty-first century, the economically important Christmas holidays are increasingly at risk under the high-emission scenario in the late twenty-first century. The overall high snow reliability of the resort comes at the cost of an increased water demand. The total water consumption of the resort will rise by 79% by the end of the century (2070–2099 compared to 1981–2010; scenario RCP8.5), implying that new water sources will have to be exploited. Future water management plans at the catchment level, embracing the stakeholders, could help to solve future claims for water in the region. [ABSTRACT FROM AUTHOR]

Background: To assess the causal relationship between a medicinal product and a reported event, relevant information needs to be present. Information elements for assessing cases of exposure to medicinal products during pregnancy were predefined and used in a new tool to assess the quality of information. However, the extent in which the presence or absence of these predefined information elements is associated with the overall clinical quality of these cases, as evaluated by pharmacovigilance experts, remains uncertain. Objective: We aimed to validate a novel method to assess the clinical quality of information in real-world pregnancy pharmacovigilance case reports. Methods: The clinical quality of case reports regarding medicinal product exposure and pregnancy-related outcomes was appraised from spontaneous reports, literature, Teratology Information Services (UK and Switzerland), The Dutch Pregnancy Drug Register, the Gilenya pregnancy registry and the Enhanced PV programme of Novartis. Assessment was done by means of the novel standardised tool based on the presence and relevance of information, and by expert judgement. The novel tool was validated compared to the expert assessment as the gold standard expressed as the area under the receiver operating characteristic curves, after which the sensitivity and specificity were calculated using cross-tabulations. Inter-rater variability was determined by means of weighted Cohen's kappa. Results: One hundred and eighty-six case reports were included. The clinical quality score as assessed by the novel method was divided into three categories with cut-off values of 45% (poor to intermediate) and 65% (intermediate to excellent). Sensitivity was 0.93 and 0.96 for poor to intermediate and intermediate to excellent, respectively. Specificity was respectively 0.52 and 0.73. Inter-rater variability was 0.65 (95% confidence interval 0.53–0.78) for the newly developed approach, and 0.40 (95% confidence interval 0.28–0.52) for the gold standard assessment. Conclusions: The tool described in this study using the presence and relevance of elements of information is the first designed, validated and standardised method for the assessment of the quality of information of case reports in pregnancy pharmacovigilance data. This method confers less inter-rater variability compared with a quality assessment by experts of pregnancy-related pharmacovigilance data. [ABSTRACT FROM AUTHOR]

Diabetes is increasing in Switzerland, but whether its management has improved is unknown. We aimed to assess diabetes prevalence, diagnosis, treatment, and control in French-speaking Switzerland. Our study used cross-sectional data for years 2005–2019 from a population-based study in Geneva, Switzerland. Overall prevalence (self-reported diagnosis and/or fasting plasma glucose level ≥ 7 mmol/L), diagnosed, treated (among diagnosed participants) and controlled diabetes (defined as a fasting plasma glucose FPG < 6.7 mmol/L among treated participants) were calculated for periods 2005–9, 2010–4 and 2015–9. Data from 12,348 participants (mean age ± standard deviation: 48.6 ± 13.5 years, 51.7% women) was used. Between 2005–9 and 2015–9, overall prevalence and frequency of diagnosed diabetes decreased (from 8.7 to 6.2% and from 7.0 to 5.2%, respectively). Among participants diagnosed with diabetes, treatment and control rates did not change from 44.1 to 51.9%, p = 0.251 and from 30.2 to 34.0%, p = 0.830, respectively. A trend towards higher treatment of participants with diabetes was found after multivariable adjustment, while no changes were found for overall prevalence, diagnosis, nor control. Among antidiabetic drugs, percentage of combinations increased from 12 to 23%; percentage of sulfonylureas and biguanides decreased from 15 to 6% and from 63 to 54%, respectively, while no trend was found for insulin. After multivariable analysis, women with diabetes were less likely to be treated but more likely to be controlled, the opposite association being found for obesity. In conclusion, in Canton Geneva, antidiabetic combination therapy is gaining importance, but only half of participants diagnosed with diabetes are treated, and glycaemic control remains poor. [ABSTRACT FROM AUTHOR]

Heart Diseases have the highest mortality worldwide, necessitating precise predictive models for early risk assessment. Much existing research has focused on improving model accuracy with single datasets, often neglecting the need for comprehensive evaluation metrics and utilization of different datasets in the same domain (heart disease). This research introduces a heart disease risk prediction approach by harnessing the whale optimization algorithm (WOA) for feature selection and implementing a comprehensive evaluation framework. The study leverages five distinct datasets, including the combined dataset comprising the Cleveland, Long Beach VA, Switzerland, and Hungarian heart disease datasets. The others are the Z-AlizadehSani, Framingham, South African, and Cleveland heart datasets. The WOA-guided feature selection identifies optimal features, subsequently integrated into ten classification models. Comprehensive model evaluation reveals significant improvements across critical performance metrics, including accuracy, precision, recall, F1 score, and the area under the receiver operating characteristic curve. These enhancements consistently outperform state-of-the-art methods using the same dataset, validating the effectiveness of our methodology. The comprehensive evaluation framework provides a robust assessment of the model's adaptability, underscoring the WOA's effectiveness in identifying optimal features in multiple datasets in the same domain. [ABSTRACT FROM AUTHOR]

In natural populations, hybridization is known to occur between a wide range of species. However, its evolutionary significance is less clear. Genes involved in fighting pathogens are considered excellent candidates for studying adaptive introgression, although both introgression and balancing selection can generate similar patterns of diversity and differentiation. Here, we compared DQA and DQB MHC class II and microsatellite allelic diversity of sympatric and parapatric mountain (Lepus timidus) and brown hare (L. europaeus) populations from Switzerland. We detected higher genetic diversity in brown hares compared to mountain hares at both MHC and microsatellite loci. We consider the observed patterns of microsatellite diversity both for L. europaeus and L. timidus as result of stochastic demographic processes while the pattern of MHC polymorphism of the studied hare populations can be explained by pathogen-driven selection. Rare bidirectional gene flow between both hare species seems to occur specifically for MHC alleles. However, the high number of shared alleles showing similar high frequency in both species suggests that reciprocally exchanged MHC alleles are being maintained via balancing selection. Adaptation to similar pathogen communities can also lead to parallel selection of MHC alleles. Positive selection, recombination and mutations have played different roles in shaping the patterns of MHC allelic diversity in and differentiation between both species. Results for the latter evolutionary forces do not show a better matching between the sympatric populations compared to the parapatric ones, suggesting a minor role of introgression for the observed evolutionary patterns of the studied hare species. [ABSTRACT FROM AUTHOR]

Tree cores are a highly valuable scientific resource. Annual growth ring data can, for example, improve our understanding of climate change impacts and effects of environmental pollution, allow for better annual estimations of tree growth patterns and carbon storage, and help quantify dynamics and changes in forest ecosystems. The value of coring trees for research has been weighted against concerns around the potential harm coring might cause to trees. To date, there is indeed limited research accurately quantifying the potential effects of coring on tree growth and only a handful of studies assessing its influence on mortality. Consequently, many European long-term forest inventorying and monitoring programs are concerned that tree coring might bias the repeated tree measurements in permanent plots, which they rely on for assessments of states and changes of forests. In this study, we assessed the effects of tree coring on the growth and mortality of three widespread European tree species approximately 10 years after they were cored. We used repeated tree measurements from permanent research sites in Switzerland and Ukraine. In Switzerland, we assessed 35 cored and 159 uncored Norway spruce (Picea abies) trees as well as 147 cored and 332 uncored silver fir (Abies alba) trees. In Ukraine, we assessed 348 cored and 6′611 uncored European beech (Fagus sylvatica) trees. We found no statistical evidence that coring negatively affected the growth or mortality of the three tree species assessed. Although we cannot rule out subtle effects on tree health and wood quality, our findings do not provide any evidence that coring affects or biases repeated measurements (such as DBH measures and recording of mortality) performed on the investigated tree species. Tree coring could therefore be considered more often for routine incorporation, particularly in long-term forest inventorying and monitoring programs and initiatives. [ABSTRACT FROM AUTHOR]

The MEG II experiment, located at the Paul Scherrer Institut (PSI) in Switzerland, is the successor to the MEG experiment, which completed data taking in 2013. MEG II started fully operational data taking in 2021, with the goal of improving the sensitivity of the μ + → e + γ decay down to ∼ 6 × 10 - 14 almost an order of magnitude better than the current limit. In this paper, we describe the operation and performance of the experiment and give a new estimate of its sensitivity versus data acquisition time. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the reasoning behind the desire to have children in non-heterosexual individuals. This study compares the motives of different sexual–romantic orientations and their preferred ways of fulfilling this desire. Methods: This was a monocentric cross-sectional study. Subjects were recruited via social media, personal contacts and queer organisations in Switzerland. An anonymous questionnaire comprised general questions about the participant's background, a validated survey about the desire to have children and additional non-validated questions addressing the impact of sexual–romantic orientation on the desire to have children. The inclusion criteria were adults without children and a completed questionnaire. Results: Of 837 participants, 642 were included in the study. Four groups of sexual–romantic orientations consisted of more than 35 participants: bisexual–biromantic (n = 38), heterosexual–heteroromantic (n = 230), homosexual–homoromantic (n = 159) and pansexual–panromantic (n = 55). Subgroups with a positive wish for a child rated all motives in the same order and with minimal numeric difference. The most important aspect seemed to be emotional involvement. Non-heterosexual–heteroromantic showed concerns about adverse reactions regarding their wish for a child. All orientations hoped for a biological child. Conclusion: Our findings about bi-, hetero-, homo- and pansexual people and their motives for a desire to have children agree with the existing literature about hetero, homo and bisexual. The impact of the fear of adverse reaction and discrimination has been discussed before and is supported by our data. We suggest better support before and during the realization of the wish for a child as well as support for non-traditional aspiring parents. [ABSTRACT FROM AUTHOR]

Introduction: Risk minimization measures are one of the most important tools in ensuring safe use of medicines. The evaluation of their effectiveness in clinical practice is a big challenge. Diclofenac is a medicine indicated for relief of all grades of pain and inflammation, in a wide range of conditions. Certain cardiovascular diseases are contraindications, whilst certain diseases require precautions for diclofenac prescribing. Objective: The aim of this study is to measure impact of the new digital risk minimization tool, introduced at the level of diclofenac prescribing, on patterns of its prescription in outpatient settings in Montenegro. Methods: Regulatory impact before/after drug utilization study, using electronic health records of patients with cardiovascular contraindications/precautions for diclofenac prescribing, was conducted. The period of observation was 1 year before and 1 year after introduction of the digital risk minimization tool. Results: Introduction of the digital risk minimization tool was associated with significant decrease in number of patients on diclofenac and the number of diclofenac prescriptions/packages, in a cohort of patients who were prescribed diclofenac before the digital intervention. Decrease in diclofenac prescription was more obvious in patients with contraindications, as expected, compared with patients with precautions. Decrease in diclofenac prescriptions in patients with other heart diseases, cerebrovascular diseases, and ischemic heart diseases (contraindications) was 38.79%, 37.62%, and 29.85% respectively. There was also a decrease in diclofenac prescriptions in patients with hypertension (22.86%), hyperlipidemia (23.61%), and diabetes mellitus (26.32%; precautions). After the digital intervention, initiation of diclofenac in diclofenac-naive patients was significantly decreased compared with patients who were prescribed diclofenac before the digital intervention. Conclusions: Although a significant decrease in diclofenac prescription in both cohorts occurred, diclofenac is still prescribed, even in diagnoses contraindicated for its use. Further improvements of existing tools and the creation of new ones are necessary for minimization of cardiovascular and other risks related to diclofenac. [ABSTRACT FROM AUTHOR]

Background: While lower extremity fractures are common injuries, concomitant compartment syndrome can lead to significant implications and surgical release (fasciotomy) is essential. The aim of this study was to identify potential predictors of compartment release and risk factors related to complications. Using a large nationwide cohort, this study compared patients suffering from lower extremity fractures with and without compartment syndrome during their primary in-hospital stay following trauma. Methods: A retrospective analysis was conducted using the prospective surgical registry of the working group for quality assurance in surgery in Switzerland, which collects data from nearly 85% of all institutions involved in trauma surgery. Inclusion criteria Patients who underwent surgical treatment for tibia and/or fibula fractures between January 2012 and December 2022 were included in the study. Statistics Statistical analysis was performed using Chi-square, Fisher's exact test, and t test. Furthermore, a regression analysis was conducted to determine the independent risk factors for fasciotomy and related complications. In the present study, a p value less than 0.001 was determined to indicate statistical significance due to the large sample size. Results: The total number of cases analyzed was 1784, of which 98 underwent fasciotomies and 1686 did not undergo the procedure. Patients with fasciotomies were identified as significantly younger (39 vs. 43 years old) and mostly male (85% vs. 64%), with a significantly higher American Society of Anesthesiologists (ASA) score (ASA III 10% vs. 6%) and significantly more comorbidities (30% vs. 20%). These patients had significantly longer duration of surgeries (136 vs. 102 min). Furthermore, the total number of surgical interventions, the rate of antibiotic treatment, and related complications were significantly higher in the fasciotomy group. Sex, age, comorbidities, and fracture type (both bones fractured) were identified as relevant predictors for fasciotomy, while ASA class was the only predictor for in-hospital complications. Outcomes Patients who underwent fasciotomy had a significantly longer hospital stay (18 vs. 9 days) and a higher complication rate (42% vs. 6%) compared to those without fasciotomy. While fasciotomy may have played a role, other factors such as variations in patient characteristics and injury mechanisms may also contribute. Additionally, in-house mortality was found to be 0.17%, with no patient death recorded for the fasciotomy group. Conclusions: Fasciotomy is vital. The knowledge about the further course is, however, helpful in resource allocation. We found significant differences between patients with and without fasciotomy in terms of age, sex, complication rate, length of stay, comorbidities, duration of operations, and use of antibiotics during their primary in-hospital stay. While the severity of the underlying trauma could not be modulated, awareness of the most relevant predictors for fasciotomy and related complications might help mitigate severe consequences and avoid adverse outcomes. [ABSTRACT FROM AUTHOR]

Unintentional introduction of natural enemies has increased in recent years due to a massive rise in global trade and tourism. One such natural enemy is the Asian egg parasitoid Trissolcus japonicus, a promising agent for classical biological control of Halyomorpha halys. In Europe, adventive T. japonicus populations have been detected in Switzerland, Italy and Germany. Host specificity testing demonstrated that its fundamental host range is fairly broad; however, it is unclear whether spatial or temporal refuges reduce parasitism of non-target species in the field. To address this, the realized host range of T. japonicus was assessed over three years by exposing sentinel egg masses of H. halys and 18 non-target species and collecting naturally laid egg masses in Switzerland and Italy. In total, 15 of 18 non-target species were successfully parasitized by T. japonicus in the field, confirming its broad fundamental host range. However, most non-target species were less parasitized by T. japonicus than H. halys, profiting from either partial temporal or spatial refuges from parasitism. Species with an unusual life cycle and the same ecological niche as H. halys, such as Pentatoma rufipes, which was the most parasitized non-target species in both countries, potentially face an increased risk of parasitism. In contrast, beneficial non-target effects may occur for the invasive pest, Nezara viridula, which suffered high non-reproductive mortality induced by T. japonicus. In both cases, life table studies will be needed to determine the impact of non-target parasitism and the potential consequences at the population level. [ABSTRACT FROM AUTHOR]

Ground support systems must provide a safe environment to personnel while maintaining the excavation functionally to ensure continuous mine's production. In addition, in burst-prone mines, these systems must be capable of resisting dynamic loading from mining induced seismic events. Hence, dynamic testing of the ground support system (combination of different reinforcement and retention elements) is required to assess the support system capacity and improve the performance of these elements under dynamic loading. During the recent years, Geobrugg has been working on improving load transfer element products (retention elements) by testing them in conjunction with different arrangements of reinforcement elements in a field-scale impact test facility located at Walenstadt, Switzerland. The test facility is composed of a double level platform of a square-shaped pyramidal truss geometry, in the upper-level housing a loading mass that drop from a height up to 5 m. The mass is guided by a central steel pipe and impacts a support system sample located at the lower level with an area of 3.6 m × 3.6 m, where the ground support system is installed. In this paper, six dynamic tests performed between 2018 and 2021 are considered. The arrangement, measurement, results, analyses, and some recommendations (conclusions) on the design of ground support under dynamic loads based on the tests performed are presented. The results of these tests have enabled to improve the understanding of the behaviour of ground support systems under dynamic loads. The main findings include a classification of the performance of mesh types used as load transfer elements and some recommendations on the design of ground support systems under dynamic loading. Among the recommendations, it is suggested the use of embedded meshes in shotcrete, and the use of load transfers materials (gap or damping materials, such as 'gabions') between the rock mass and the ground support system to improve the performance. Highlights: New results of dynamic behaviour of ground support systems studied through field-scale dynamic impact test. Improved understanding of the dynamic behaviour of ground support systems involving mesh, shotcrete and rockbolts. Conclusions relevant for the design of ground support systems under dynamic loading. Relevant results for underground mining design under high stress conditions and burst-prone ground. [ABSTRACT FROM AUTHOR]

Nagra, the cooperative for developing and implementing a long-term radioactive waste depository in Switzerland, identified Opalinus Clay as the most suitable host rock for deep geological containment. This paper deals with those features of Opalinus Clay that are important for the design and construction of the underground structures. Consolidated drained (CD) and consolidated undrained (CU) triaxial compression tests on specimens from deep boreholes revealed that Opalinus Clay exhibits pronounced stiffness and strength anisotropy, dependency of stiffness on the initial confining pressure, slightly non-linear pre-failure stress–strain behaviour, and a drop in axial resistance after a certain amount of shearing. Within the scope of establishing a rigorous—yet practical—design approach for the repository tunnels and caverns, the simplest possible constitutive model capable of reproducing the main aspects of the Opalinus Clay behaviour is adopted. The non-associated linear elastic and perfectly plastic MC model is chosen as a starting point, on account of its wide use in tunnel engineering practice, its simplicity, and the clear physical meaning of its parameters. This paper presents a systematic and robust calibration method for an extended version of this model, which considers the pronounced strength and stiffness anisotropy of Opalinus Clay. The paper additionally provides the full suite of the equations that describe the model behaviour under triaxial CU or CD testing conditions and for any bedding orientation relative to the specimen axis. The equations are employed to determine ranges of material constants for two varieties of Opalinus Clay, based upon the results of 73 CU and CD tests. A thorough comparison between the model predictions and the experimental response is conducted, to demonstrate the versatility and limitations of the constitutive model and of the proposed calibration approach. Highlights: A large number of CD and CU triaxial compression tests was evaluated. The adequacy of a simplified non-linear anisotropic material model was assessed. The prediction and calibration equations for the model were provided. The strength and stiffness constants of Opalinus Clay were determined based on the large experimental database. [ABSTRACT FROM AUTHOR]

Background: Endotoxin adsorption is a promising but controversial therapy in severe, refractory septic shock and conflicting results exist on the effective capacity of available devices to reduce circulating endotoxin and inflammatory cytokine levels. Methods: Multiarm, randomized, controlled trial in two Swiss intensive care units, with a 1:1:1 randomization of patients suffering severe, refractory septic shock with high levels of endotoxemia, defined as an endotoxin activity ≥ 0.6, a vasopressor dependency index ≥ 3, volume resuscitation of at least 30 ml/kg/24 h and at least single organ failure, to a haemoadsorption (Toraymyxin), an enhanced adsorption haemofiltration (oXiris) or a control intervention. Primary endpoint was the difference in endotoxin activity at 72-h post-intervention to baseline. In addition, inflammatory cytokine, vasopressor dependency index and SOFA-Score dynamics over the initial 72 h were assessed inter alia. Results: In the 30, out of 437 screened, randomized patients (10 Standard of care, 10 oXiris, 10 Toraymyxin), endotoxin reduction at 72-h post-intervention-start did not differ among interventions (Standard of Care: 12 [1–42]%, oXiris: 21 [10–51]%, Toraymyxin: 23 [10–36]%, p = 0.82). Furthermore, no difference between groups could be observed neither for reduction of inflammatory cytokine levels (p = 0.58), nor for vasopressor weaning (p = 0.95) or reversal of organ injury (p = 0.22). Conclusions: In a highly endotoxemic, severe, refractory septic shock population neither the Toraymyxin adsorber nor the oXiris membrane could show a reduction in circulating endotoxin or cytokine levels over standard of care. Trial registration ClinicalTrials.gov. NCT01948778. Registered August 30, 2013. https://clinicaltrials.gov/study/NCT01948778 [ABSTRACT FROM AUTHOR]

Purpose: To investigate time trends in daily fruit consumption among Western European adolescents and in related socioeconomic inequalities. Methods: We used nationally representative data from 18 countries participating in five rounds (2002 to 2018) of the cross-sectional "Health Behaviour in School-aged Children" (HBSC) survey (n = 458,973). The questionnaire, standardised across countries and rounds, was self-administered at school by 11-, 13- and 15-year-old adolescents. Daily fruit consumption was assessed using a short food frequency questionnaire (sFFQ). Socioeconomic inequalities were measured using the Family Affluence Scale (FAS). Multilevel logistic regressions were applied to study linear time trends in daily fruit consumption, overall, by country and by FAS. Results: Between 2002 and 2018, daily fruit consumption increased in 10 countries (OR range, 1.04 to 1.13, p < 0.05) and decreased in 3 (OR range 0.96 to 0.98, p < 0.05). In all survey years combined, prevalence of daily fruit consumption was significantly higher among high FAS groups (42.6%) compared to medium (36.1%) and low FAS groups (31.7%; all countries: p < 0.001). Between 2002 and 2018, socioeconomic inequalities in fruit consumption increased in Austria, Germany, Italy, Netherlands, Scotland, Sweden, and Switzerland. Only in Norway FAS inequalities decreased while the prevalence increased. Conclusion: The prevalence of daily fruit consumption generally increased among adolescents between 2002 and 2018 in Western European countries, yet socioeconomic inequalities increased in some countries. Public health interventions should continue to promote fruit consumption with special attention to lower socioeconomic groups. [ABSTRACT FROM AUTHOR]

Background: Malignant pleural mesotheliomas (MPMs) are aggressive and often unresectable. In the past, chemotherapy was the standard for palliative treatment. However, immunotherapy with nivolumab+ipilimumab has recently received marketing approval. Objectives: This study evaluated the cost effectiveness of nivolumab+ipilimumab versus pemetrexed+platinum (with/without bevacizumab) for Swiss patients with unresectable MPM, overall and by histological subtype. Methods: We developed a three-state Markov cohort model with a cycle length of 1 month, a 30-year time horizon, and a discount rate of 3% per year for costs and benefits. The model included the updated survival and treatment-dependent utility results from the Checkmate-743 and MAPS registration trials. A Swiss statutory health insurance perspective was considered with unit costs for 2022 from publicly available and real-world sources. We assumed a willingness-to-pay (WTP) threshold of CHF100,000/QALY. Model robustness was explored in sensitivity and scenario analyses. Results: Compared with chemotherapy, nivolumab+ipilimumab incurred additional costs of CHF109,115 and 0.57 additional quality-adjusted life-years (QALYs), yielding an incremental cost-effectiveness ratio (ICER) of CHF192,585/QALY (i.e. USD201,829/QALY) gained. Relative to their 2022 list price, nivolumab+ipilimumab may be cost effective if priced at 48% across all histologies. Assuming cisplatin-based instead of carboplatin-based chemotherapy reduced the ICER to CHF158,911/QALY (i.e. USD166,539/QALY). For the non-epithelioid subtype, nivolumab+ipilimumab was cost effective compared with chemotherapy (ICER of CHF97,894/QALY, i.e. USD102,593/QALY). Chemotherapy+bevacizumab was often a dominated strategy or would require a bevacizumab cost reduction to 28%. Conclusions: Our model projected nivolumab+ipilimumab to be cost effective for the non-epithelioid subtype but not for all histologies. Substantial discounts for nivolumab+ipilimumab would be necessary to achieve cost effectiveness for all histologies. [ABSTRACT FROM AUTHOR]

Purpose: Revision total knee arthroplasty (RTKA) results in high costs with inadequately low reimbursement in different healthcare systems. Therefore, a financial analysis was performed comparing costs and reimbursements of primary total knee arthroplasty (PTKA) versus RTKA using financial and total knee arthroplasty-register data from a large tertiary hospital, the Cantonal Hospital of St. Gallen (KSSG), Switzerland. Methods: All PTKA and RTKA performed between January 2012 and September 2019 at the KSSG were included. Financial and TKA-register data for each case were collected, including detailed cost allocation, reimbursement, patients' insurance status, type and indication for surgery and length of hospital stay. RTKA was further subdivided in one-stage and two-stage RTKA. Direct hospital costs were analyzed and compared to reimbursement in both groups. Cost-coverage ratios were calculated. Results: 730 PTKA and 106 RTKA were included. The RTKA group contained 66 one-stage and 40 two-stage RTKA. Cost-coverage ratio for PTKA and RTKA showed to be 110.9% and 81.3%, respectively. Cost-coverage ratio was lower for two-stage RTKA than for one-stage RTKA with 74.1% and 92.3%, respectively. Conclusion: RTKA leads to financial deficits especially for tertiary hospitals within the Swiss healthcare system. Restructuring of the reimbursements for PTKA and RTKA should be considered in favor of RTKA. Otherwise, tertiary hospitals will face a growing financial burden with the constantly increasing annual number of RTKA procedures, predominantly performed in this type of hospitals. Level of evidence: III. [ABSTRACT FROM AUTHOR]